From Strength to Strength

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It is with great pleasure that I am able to update you on the success of the Faculty of Perioperative Care, which has now completed its second year as a part of The Royal College of Surgeons of Edinburgh (RCSEd). Established in March 2016 to provide education, training and support for advanced practitioners in the field of surgery, the faculty offers practitioners an opportunity to network as well as sharing experiences and practices.

A flourishing Faculty – Rising membership numbers and a new Fellowship category

The Faculty was delighted to confirm its first full member in November of last year, with John Stirling elected at one of the College’s prestigious Diploma ceremonies. Incidentally, John is neither a surgical care practitioner nor a surgical first assistant, but satisfied all the criteria in the five of the domains! Following on from John, several more applications have been assessed and approved, with their Diploma ceremonies taking place in the coming months. Along with their Diplomas, successful candidates can, upon satisfying the criteria for full membership, be awarded the post-nominals MFPCEd.

Membership is not the only way the Faculty will grow, with Fellowship invitations being made to senior practitioners and surgeons who have made a major contribution to the education, teaching and training of this workforce, or the development of the wider field of perioperative care internationally.

Courses and Conferences

An essential aspect of the Faculty of Perioperative Care is the establishment of our bespoke educational courses. Our Principles of Anatomy, Non-Technical Skills (PINTS) and Leadership and Development are accredited by the Association for Perioperative Practitioners (AfPP), and run specifically for this group of non-medical practitioners (NMPs).

Our Perioperative Key Skills course was first run a year ago and is now designed to accommodate the surgical first assistant (SFA)’s extended scope of practice to allow these practitioners to undertake superficial suturing and haemostasis under direct supervision. This course also offers best practice assisting in laparoscopic and robotic surgery. This year, I am pleased we have extended our educational offering to these practitioners by opening our Basic Surgical Skills courses, as well as our Care of the Critically Ill Surgical Patient courses (CCrISP) to those involved in the post-operative care of the patient. These courses are run by the College at several locations across the UK, and highlight the inclusion of the new Faculty with the wider College.

Embracing the Complete Surgical Team at our Conferences

The Faculty’s third annual conference ‘The Surgical Team: are Perioperative Practitioners increasingly working towards a Medical Model of Care’ was held in Birmingham, back in November of 2017. With around 100 delegates from across the UK in attendance, the feedback was extremely positive with 96% of delegates responding with an overall good to excellent rating, with 100% stating they would be recommending future conferences to their colleagues.

More recently, RCSEd held its Triennial conference ‘The Modern Surgical Team: the Future of Surgery’. Sessions on the workforce required for the surgical team and challenging the traditional model of care involved several speakers who have already contributed to our Faculty over the past couple of years and have previously spoken at Faculty conferences.

Building on the success of our recent conferences, we are now developing the programme for our fourth annual conference - ‘The Perioperative Practitioner: Working Within One’s Scope of Practice’ which will be held in Birmingham on 3 November 2018. Confirmed speakers so far include Michael Lewis, Consultant Cardiothoracic Surgeon in Brighton, Richard Montgomery, Professor of Trauma and Orthopaedic Surgery at the James Cook University Hospital and Alice Hartley, Chair of RCSEd’s #LetsRemoveIt anti-bullying campaign. This conference will address important topics such as competency assessment and appraisal for SCPs and SFAs, provide an update on share decision making and informed consent, as well as providing the results of a UK wide surgical assistant project.

Working in Partnership with Universities

Over the past year, I have visited perioperative colleagues at Teeside, Anglia Ruskin, Plymouth and Edgehill Universities, to lecture students and trainee practitioners about the Faculty and what RCSEd can offer them following graduation. I am delighted to announce that as a result we have recently extended free Affiliate membership of the Faculty to MSc students in Surgical Care Practice at these establishments.

In addition to providing educational support for these practitioners, RCSEd is also leading the way in the development of a national summative assessment of surgical care practitioners in the UK. Under the chairmanship of Consultant Cardiothoracic Surgeon Norman Briffa, the Cardiac exam for surgical care practitioners (SCPs) in Cardiac Surgery has undergone changes over the past year to structured based assessments (SBAs) and a structured vivas format, meaning the exam Is now associated with a more robust regulation. This development of a specialty exam has been presented to the Presidents of the Surgical Specialties as a blueprint for other areas to follow, offering one way of improving the credibility of practitioners such as SCPs, with not only the general public but also within the medical profession.

As well as working with the Perioperative Care Collaborative (FPC) in establishing the new Surgical First Assistant Position Statement in April 2018, I have been closely involved with the Medical Associates Oversight Board (MAOB ) - run by Health Education England (HEE). Furthermore, I now chair a Task and Finish group looking at the use of competency and conduct assessment in developing a common standard for appraisal across the 4 groups of practitioner ( SCP, PA,PAA and ACCP ) being considered for statutory regulation. The Department of Health issued a consultation document ‘Regulation of Medical Associate Professions in the UK’ in 2017, and RCSEd responded robustly in favour of statutory regulation for all the above groups. At the time of this report a final decision by DH is awaited.

Finally, the Faculty has been involved in carrying out audit of relevant practice in the UK. Under the leadership of Clinical Leadership Fellow Alistair Geraghty, the report has discovered some interesting preliminary findings. It would appear that 29% surgeons are not satisfied with the quality of assistance they receive in theatre and 50% would have difficulty in obtaining a second assistant if required. 61% employ NMPs in theatre and although only 7% of consultants feel that these practitioners may have an adverse effect on training surgical trainees, this figure rises to over 60% with ST3-5 trainees. Further analysis of this project is underway and final results will be published by the end of the year.

The Faculty has gone from strength to strength over the last year, with great plans for our future being made. We are aiming to expand our partnerships with universities, are currently exploring an international arm of the Faculty in countries where advanced practitioners are employed, and are working hard to extend membership of the Faculty to other practitioner groups within the UK. We look forward to delivering this success, and are excited to welcome more members to the Faculty in the coming weeks and months.